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Background: With increasing survival following the use of antiretroviral therapy, adolescents living with Human Immunodeficiency Virus (ALHIV) could have complications such as delayed puberty and psychological complications. In Nigeria, there is limited data on the association between delayed sexual maturation and psychosocial dysfunction in ALHIV. The objective of this study was to determine the prevalence and the association between delayed sexual development (DSD) and psychosocial dysfunction (PSD) in ALHIV and compare it with uninfected adolescents. Methodology: This was a cross-sectional study conducted at the Lagos University Teaching Hospital (LUTH), Nigeria and it involved 144 ALHIV and an equal number of HIV-negative controls who were matched for age, sex and social class. Information was obtained from participants using interviewer-administered questionnaires; their stages of sexual development and their psychosocial function were assessed using Tanner staging criteria and the Paediatric Symptom Checklist tool respectively. Data were analysed using the Statistical Package for Social Sciences software version 23. Results: The mean (±SD) age of ALHIV and the HIV-negative controls was 14.8 (±3.0) and 14.8 (±2.9) years respectively. All the ALHIV were on HAART and 99.3% were in clinical stage 1. There was no significant difference between the prevalence of DSD among the ALHIV (9.4%) and the HIV-negative controls (6.4%) (p= 0.402). The prevalence of PSD in ALHIV and HIV-negative controls were 4.9% and 5.6% respectively (p=0.791). There was no significant association between PSD and DSD in both groups of study participants (p=0.459 and p=0.301). Conclusion: The prevalence of PSD and DSD were low and similar among adolescents with and without HIV, and no association was found between PSD and DSD. However, routine screening of adolescents for PSD should be practised for early identification and prompt management where indicated. [ABSTRACT FROM AUTHOR]

A 19-year-old male with type 1 diabetes mellitus (diagnosed at 12 years of age) was brought to the emergency room with fever and altered sensorium. His compliance with his insulin regimen was questionable. Examination revealed a Glasgow Coma Scale of 5/15, sluggishly-reacting pupils, severe dehydration, and fever (temperature 38.8°C). Vital signs at the upper limit of normal, urethral catheter drained dark red urine with output of 1–2 ml/kg/hr. Laboratory investigations showed hyperglycemia (250 mg/dL), ketonuria (+) hematuria (+++) and proteinuria (++), and glycated hemoglobin (HbA1C) – 9.6%. Full blood count showed leukopenia, neutrophilia, and thrombocytopenia. Deranged electrolytes included hypernatremia, metabolic acidosis, and hypophosphatemia with elevated urea and blood urea nitrogen. Serum creatinine kinase (CK) was elevated. A diagnosis of diabetic ketoacidosis (DKA) with rhabdomyolysis (RM) and raised intracranial pressure was made and he was managed with adequate fluid resuscitation, osmotic diuresis, glycemic control, platelet transfusion, and antibiotics with clinical improvement. Normal CK levels were documented 3 months later. RM is a rare complication of DKA. High index of suspicion should be maintained for prompt detection and management to prevent potential complications, especially acute kidney injury. [ABSTRACT FROM AUTHOR]

Abstract Background Childhood obesity and associated hypertension are major public health concerns globally. This study aimed to determine the prevalence of obesity and the associated risk of high blood pressure among Nigerian adolescents. Methods A cross-sectional school-based study of 885 apparently healthy adolescents was performed. Weight, height and blood pressure (BP) were measured using standard methods. Body mass index (BMI) was calculated and categorized by age, sex and percentile. Obesity and overweight were defined as: ≥ 95th and 85th to < 95th percentiles, respectively, for age, sex and height. Subjects were sub-categorized into age 10–13 years (A) and 14–17 years (B). The odds ratio for pre-hypertensive and hypertensive range BP by age and BMI were generated. Significance was set at P Results The prevalence of overweight and obesity were 13.8% and 9.4%, respectively. The prevalence of hypertensive range systolic BP in obese versus normal BMI females was 16% versus 23% (p=0.00) and 12.1% versus 6.4% (p=0.27) in males. The prevalence of hypertensive range diastolic BP in obese versus normal BMI females was 12% versus 1.4% (p=0.00) and 15.2% versus 3.5% (p=0.01) in males. BMI in group B was significantly associated with pre-hypertensive and hypertensive range systolic BP in overweight (P = 0.01, P = 0.002) and obese subjects (P = 0.00, P = 0.00) and with hypertensive range diastolic BP (P = 0.00) only in obese subjects. The only significant association in group A was between obesity and pre-hypertensive range diastolic BP (P = 0.00). Conclusion The prevalence of hypertensive range BP among obese Nigerian adolescents was high. Screening for childhood obesity and hypertension, and long-term follow-up of obese adolescents into adulthood are recommended.

Abstract Background In the Sub Saharan Africa Rickets has now been established to be due primarily to calcium deficiency and sometimes in combination with vitamin D deficiency. The main thrust of management is calcium supplementation with or without vitamin D. An observation was made that some children with nutritional rickets do not respond to this management modality. The recently reported high prevalence of Incomplete Distal Renal Tubular Acidosis (idRTA) in adults with osteoporosis as brought to fore the possibility of this being a possible cause of calcium wastage and therefore the poor response in these group of children with rickets. Aim To determine the prevalence of idRTA amongst a cohort of subjects with rickets To show a relationship between rickets and incomplete distal renal acidosis To determine the response of children with rickets and idRTA to addition of Shohl's solution to therapy Methodology Two separate cohorts of children with rickets performed the ammonium chloride loading test to detect those with incomplete renal tubular acidosis. Following identification for idRTA, Shohl's solution was added to therapy of calcium and vitamin D supplementation and their response compared to those without idRTA on calcium and vitamin D supplementation solely. Results 50 children with rickets aged from two to six years of age and composed of 29 females and 21males were investigated. Incomplete renal tubular acidosis was found in 38% of them. Prevalence of idRTA was highest amongst those aged 3-6 years of age. Those with idRTA had worse limb deformities, biochemical and radiological parameters than those who hadn't. Rate of response on those with idRTA treated with Shohl's solution was at par with those without idRTA. Conclusion Incomplete idRTA exist amongst children with rickets and should be looked out for in severe rickets and older children. Treatment of idRTA will lead to optimal response and healing of rickets.

Phaeochromocytoma (PCC) is a rare catecholamine-secreting tumor derived from the sympathetic nervous system's chromaffin cells. Pheochromocytomas are exceptionally rare in children and are responsible for about 1% of pediatric hypertensive patients [1]. They arise most commonly in the adrenal glands (approximatively 85% of tumors)[1] but may also arise from chromaffin cells of the sympathetic nervous system, known as paragangliomas (PGLs). The tumors are more common in boys than girls, with a 2:1 ratio of boys to girls in pediatric PCC/PGL cohorts [2]. PCC/PGL often occur as sporadic tumors, but may sometimes occur as part of hereditary tumor syndromes, mainly Von Hippel Lindau (VHL) disease and multiple endocrine neoplasia (MEN) type 2A and 2B [1]. About 50% of cases are missed and discovered at autopsy because the diagnosis was not considered at presentation [3]. We report this case of phaeochromocytoma to draw the attention of clinicians in our environment to this unusual cause of pediatric hypertension and the need for a thorough investigation of the hypertension etiology of in children. We also underline the fact that this feared tumor can be successfully managed even in areas with limited resources, such as ours. Finally, we encourage physicians to measure blood pressure of children presenting to their clinics. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid disorders account for a large proportion of pediatric endocrine disorders. Untreated hypothyroidism in childhood has permanent adverse effects on physical, intellectual, and neurological development. However, few studies have reported the pattern of pediatric thyroid disorders in Nigeria. Objectives: The objective of this study was to document the pattern of thyroid disorders in children and adolescents seen at the Lagos University Teaching Hospital (LUTH) over a 10-year period. Participants and Methods: This is a retrospective descriptive study involving children with thyroid disorders seen from January 1, 2006 to December 31, 2015. Results: Seventy-one patients with thyroid disorders (0.13%) were seen out of 52,800 new cases (incidence of 1/1000 new cases) comprising 13.4% of 546 pediatric endocrine cases with a male:female ratio of 1:1.2. Median (range) age at presentation was 1.6 (0.001–14) years. Congenital hypothyroidism (CH) constituted a major proportion of cases (46.7%), with a median (range) age at presentation of 9 (1.5–24) months. Down syndrome constituted 45% of patients with CH with associated congenital heart defects in eight (53%) patients. Acquired hypothyroidism was seen in ten patients (five goitrous and five nongoitrous). Six patients had hypothyroidism associated with multiple anterior pituitary hormone deficiency. Nine patients (all females) had hyperthyroidism with confirmed Graves' disease in 5 (55.6%), with mean age at presentation being 9.4 ± 2.09 years. Other conditions were euthyroid sick syndrome (2.8%), euthyroid goiter (1.4%), and acute thyroiditis (1.4%). Eight infants of mothers on treatment for hyperthyroidism ( first seen between the 7th h of life to 2 months of age) had transient hypothyroidism while one 8-day-old had transient hyperthyroidism. Conclusion: CH was the most common disorder encountered with late age at presentation. Routine newborn screening and maintaining a high index of suspicion are advocated. [ABSTRACT FROM AUTHOR]

Background: While there is currently much emphasis on the developmental origins of diseases associated with deranged metabolism in developed societies, there is a paucity of data on this subject in developing countries. Insulin resistance (IR) at birth is known to be the earliest detectable abnormality in the natural history of diabetes. It is also a precursor of obesity and cardiovascular diseases. Objective: The objective of the study was to determine IR profile in apparently healthy term neonates. Methods: The cross-sectional study involved 33 small for gestational age (SGA), 29 appropriate for gestational age (AGA), and 38 large for gestational age (LGA) healthy neonates <48 h of age. Glucose and insulin samples taken after a shortened fasting time were measured with glucose oxidase and Enzyme-linked immunosorbent assay methods, respectively. Homeostatic model assessment of IR (HOMA-IR) was calculated. Results: The mean fasting glucose, fasting insulin, and HOMA-IR were 2.66 ± 0.7 mmol/L, 8.68 ± 3.63 μU/mL, and 1.01 ± 0.46, respectively. Fasting glucose levels in LGA, AGA, and SGA neonates were 2.92 ± 0.76 mmol/L, 2.58 ± 0.53 mmol/L, and 2.45 ± 0.68 mmol/L, respectively (p = 0.012). Insulin levels of LGA, AGA, and SGA were 9.47 ± 4.77 μU/mL, 8.44 ± 2.03 μU/mL, and 7.98 ± 3.08 μU/mL, respectively (p = 0.207). HOMA-IR of LGA, AGA, and SGA was 1.18 ± 0.54, 0.97 ± 0.32, and 0.86 ± 0.40, respectively (p = 0.01). The correlation coefficient, r, between HOMA-IR and birth weight was 0.72 (p < 0.001) and the correlation coefficient between HOMA-IR of neonates and maternal body mass index (BMI) was 0.51 (p = 0.001). Conclusions: LGA and infants delivered to mothers with higher BMI are at a higher risk of IR and should be screened at birth. [ABSTRACT FROM AUTHOR]

Background: World Health Organization has predicted a worldwide rise in the prevalence of diabetes mellitus. Cote d’Ivoire is not exempted as evidenced by such factors as obesity and sedentary life style amongst others. The objective of the study was to determine the prevalence of diabetes mellitus (DM) among children and adolescents in the district of Abidjan in Cote d’Ivoire. Methods: A cross-sectional descriptive survey using a multi-stage sampling approach was conducted from March to April 2013. 1572 children and adolescents aged 02–19 years were surveyed in 687 randomly selected households in three municipalities. Capillary fasting glucose was performed in all subjects, and when abnormal was followed by an Oral Glucose Tolerance Test (OGTT). Definitions of Impaired Fasting Glucose (IFG) and DM (Diabetes Mellitus) were according to International Society for Paediatric and Adolescent Diabetes (ISPAD) Guidelines. Results: The prevalence of DM and IFG were 0.4 % and 14.5 % respectively. There was no significant differences between patients with different glycemic status in terms of ethnicity/nationality (p = 0.98) or gender (0.079). In the rural areas, 565 (81.1 %) subjects were normoglycaemic and 132 (18.9 %) subjects hyperglycaemic while there were 773 (88.3 %) normoglycaemic subjects and 102 (11.7 %) hyperglycaemic subjects respectively from the urban areas of residence and this difference was statistically significant (p = 0.000). The prevalence of diabetes mellitus was identical (0.4 %) in the two age groups (2–9 years and 10–19 years). Seventy-seven (4.9 %) children who participated in the study had at least one diabetic parent. The proportion of participants with a diabetic father (59, 3.8. %) was twice the proportion with a diabetic mother (30,1.9 %) and this was statistically significant (p = 0.002). Only 10 out of 228 patients with IFG reported for the follow up OGTT and no impaired glucose tolerance was identified in these patients. Conclusion: The prevalence rate of DM among children and adolescents was 0.4 %. Nationwide awareness campaigns and prevention programmes about diabetes in childhood should be instituted and existing ones strengthened. Adequate commitment from the relevant stakeholders especially the country’s ministry of health is also advocated to stem this looming epidemic. [ABSTRACT FROM AUTHOR]

Background: Congenital hypothyroidism is a common congenital endocrine disorder prevailing all over the world. No nationwide screening exists for any sub-Saharan country. We present normative cord and capillary thyroid-stimulating hormone (TSH) values for healthy Nigerian newborns. Subjects and Methods: A cross-sectional study was carried out in 6 university hospitals in Nigeria between January 1 and December 31, 2013. Cord and heel blood placed on 4 concentric circles on a Whartman filter paper were analysed for TSH within 1 week of collection using AutoDelfia 1235 immunoassay (Perkin Elmer Wallace, Boston, Mass., USA) at Charité - Universitätsmedizin Berlin, Berlin, Germany. The mean TSH levels of the newborns were determined, considering their sex, birthweight, socioeconomic status, and birth city. The association between the mean TSH level and other parameters was determined by analysis of variance. Results: A total of 2,014 subjects were recruited during the study period. The mean TSH value for the subjects was 1.86 μIU/ml, and 98.1% of the newborns were within the 2.5th and 97.5th percentiles (range: 0.09-7.90 μIU/ml) of the TSH levels. We collected 247 cord and 1,767 heel samples, respectively, and the range was slightly higher in samples from cord blood. Conclusion: The study highlights the normal reference values for capillary/cord TSH levels in term Nigerian newborns. TSH was higher in one region, attributable to earlier sampling, but was not influenced by gender, socioeconomic status, or birthweight. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Thyroid disorders account for a large proportion of pediatric endocrine disorders. Untreated hypothyroidism in childhood has permanent adverse effects on physical, intellectual, and neurological development. However, few studies have reported the pattern of pediatric thyroid disorders in Nigeria., Objectives: The objective of this study was to document the pattern of thyroid disorders in children and adolescents seen at the Lagos University Teaching Hospital (LUTH) over a 10-year period., Participants and Methods: This is a retrospective descriptive study involving children with thyroid disorders seen from January 1, 2006 to December 31, 2015., Results: Seventy-one patients with thyroid disorders (0.13%) were seen out of 52,800 new cases (incidence of 1/1000 new cases) comprising 13.4% of 546 pediatric endocrine cases with a male:female ratio of 1:1.2. Median (range) age at presentation was 1.6 (0.001-14) years. Congenital hypothyroidism (CH) constituted a major proportion of cases (46.7%), with a median (range) age at presentation of 9 (1.5-24) months. Down syndrome constituted 45% of patients with CH with associated congenital heart defects in eight (53%) patients. Acquired hypothyroidism was seen in ten patients (five goitrous and five nongoitrous). Six patients had hypothyroidism associated with multiple anterior pituitary hormone deficiency. Nine patients (all females) had hyperthyroidism with confirmed Graves' disease in 5 (55.6%), with mean age at presentation being 9.4 ± 2.09 years. Other conditions were euthyroid sick syndrome (2.8%), euthyroid goiter (1.4%), and acute thyroiditis (1.4%). Eight infants of mothers on treatment for hyperthyroidism ( first seen between the 7 th h of life to 2 months of age) had transient hypothyroidism while one 8-day-old had transient hyperthyroidism., Conclusion: CH was the most common disorder encountered with late age at presentation. Routine newborn screening and maintaining a high index of suspicion are advocated., Competing Interests: There are no conflicts of interest.

On behalf of the Global Pediatric Endocrinology and Diabetes group, the authors provide a perspective on the rights of a child as enshrined in the United Nations Convention on the Rights of the Child (1989) concerning the care of pediatric endocrine disorders and diabetes mellitus, throughout the world, with particular reference to care in resource-constrained settings. In this article, we define the spectrum of health care needs of the child with an endocrine disorder and how they may be addressed, in terms of education, research, and development of sustainable programs for improved health outcomes. We emphasize the responsibilities of medical communities, the pharmaceutical industry, and relevant governments in promoting and supporting such concepts.